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Appendix D A Systematic Review of Costs Associated with Preterm Birth
Pages 688-724

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From page 688...
... In the context of this review of costs of initial hospitalization, these include costs for the hospital bed and support services ("accommodation") , ancillary services (pharmacy, radiology, laboratory, and respiratory care services)
From page 689...
... 689 APPENDIX D These include overhead expenditures for housekeeping, administration, and the physical plant. Costs to patients include nonmedical direct costs (such as the cost of transportation to the hospital, meals, and child care for other siblings)
From page 690...
... However, studies from middle-income and developing countries were excluded on the grounds that both outcomes and health care delivery cost structures are too different to interpret the applicability of the results in the U.S. context.
From page 691...
... 691 APPENDIX D searches. For other databases, the keywords "econom*
From page 692...
... 692 TABLE D-1A Studies of Costs During Initial Hospitalization Date of Location Type of Currency Paper Cohort of Cohort Cohort Sample Size Currency Date Adams (13) 1996 US Convenience sample Total: 12,125 USD Not specified Normal preterm: 456 Extreme preterm: 513 Normal full term: 9,179 Brazier (14)
From page 693...
... Luke (20) 1991-1992 Illinois Hospital-specific Twins: 111 USD Not specified Singletons: 106 Marbella (21)
From page 694...
... 694 TABLE D-1B Studies of Costs During Initial Hospitalization Gestational Birth Costs Cost vs Data Paper Age Weight Included Charges Sources Uncertainty Adams (13) Not specified Not specified Hospital; Paid claims Claims database Not specified (premature and professional extreme preterm defined by ICD9)
From page 695...
... Marbella (21) Not specified All Hospital Charges State-level linked Not specified (premature vital statistics and defined as all discharge records prematurity related DRG)
From page 696...
... 696 TABLE D-2A Studies of Costs Following Discharge from Initial Hospitalization Date of Location Type of Currency Paper Cohort of Cohort Cohort Sample Size Currency Date Broyles (28) 1988-1996 Texas Hospital-specific 388 (control USD 1997 group of RCT)
From page 697...
... Petrou (34) 1978-1988 UK Geographic (regional)
From page 698...
... 698 TABLE D-2B Studies of Costs Following Discharge from Initial Hospitalization Gestational Birth Costs Cost vs Data Paper Age Weight Included Charges Sources Uncertainty Discounting Broyles (28) Not specified <1000 or <1,500 Hospital; CCR Prospective Statistical 3% and ventilated outpatient (department- research except drugs specific)
From page 699...
... Medstat (41) Not specified All Hospital; Paid claims Marketscan Not specified Not specified outpatient proprietary medical; drugs database of 100 payers Petrou (33)
From page 700...
... TABLE D-2B Continued 700 Gestational Birth Costs Cost vs Data Paper Age Weight Included Charges Sources Uncertainty Discounting Rolnick (37) Not specified >1,500 Hospital; Charges Claims database Statistical Not specified Outpatient MD except drugs Roth (38)
From page 701...
... 701 APPENDIX D The inconsistent level of regionalization in neonatal care delivery makes the nature of the cohort critically important for cost analyses of prematurity. Six of the reports (12, 16, 18, 21, 25, 27)
From page 702...
... 702 PRETERM BIRTH quantification of statistical or parameter uncertainty. Statistical uncertainty was reported in only three studies (20, 25, 27)
From page 703...
... 703 APPENDIX D The majority of long-run studies were from broadly representative cohorts. These geographically based cohorts were at the regional (27, 33–35, 39, 40)
From page 704...
... 704 PRETERM BIRTH more complex exercise, requiring the assembly of data from multiple sources. In some studies, this led to a large number of assumptions regarding the applicability of data, the choice of unit costs, and natural history (29, 31)
From page 705...
... 705 APPENDIX D Corresponding U.S. population projections were as follows: for infants born at 25 to 29 weeks gestation, $100 million; for infants born at 30 to 34 weeks gestation, $429.5 million; and for infants born at 37 to 38 weeks gestation $1.94 billion.
From page 706...
... 706 PRETERM BIRTH claims databases from large third-party payers. Chollet et al.
From page 707...
... 707 APPENDIX D longer-term costs included infants across the birth weight and gestational age spectra. Comorbid and Resulting Conditions The studies retrieved did not make any attempt to attribute postdischarge costs to particular neonatal or postnatal conditions other than birth weight or gestational age.
From page 708...
... 708 PRETERM BIRTH TABLE D-3 Direct Medical Costs During Initial Hospitalization Per Per Patient Cost - Per Patient Cost Patient 2005 Dollars 2005 Dollars Study Cost Using Medical CPI Using Hospital PPI Adams (13) Normal preterm: 10,416 Normal preterm: 14,634 Normal preterm: 13,506 Extreme preterm: 49,933 Extreme preterm: 70,151 Extreme preterm: 64,744 Normal full-term: 1,139 Normal full-term: 1,600 Normal full-term: 1,477 Chollet (15)
From page 709...
... 709 APPENDIX D US Population US Population Cost Projection - Cost Projection - Per-Patient Per-Patient 2005 Dollars 2005 Dollars Per-Patient Ventilator Maternal Using Medical CPI Using Hospital PPI LOS Days Costs <37 weeks: 7.04 billion <37 weeks: 6.50 billion Normal preterm: 6.1 N/A Normal preterm: 10,626 <28 weeks: 2.06 billion <28 weeks: 1.90 billion Extreme preterm: 19.9 Extreme preterm: 11,508 37-41 weeks: 5.17 billion 37-41 weeks: 4.77 billion Normal full-term: 1.9 Normal full-term: 7,452 <37 weeks: 13.38 billion <37 weeks: 10.78 billion N/A N/A Normal preterm: 13,017 <28 weeks: 2.95 billion <28 weeks: 2.38 billion Extreme preterm: 14,815 37-41 weeks: 13.9 billion 37-41 weeks: 11.20 billion Normal full-term: 7,850 500-999 grams: 500-999 grams: 500-999: 500-999: N/A 1.94 billion 1.81 billion 82.1 per live birth 34.4 per live birth <37 weeks: 4.62 billion <37 weeks: 4.26 billion 25 week survivor: 92 N/A 25 week survivor: 7,500 30-34 weeks: 1.87 billion 30-34 weeks: 1.73 billion 30 week survivor: 30.4 30 week survivor: 7,200 500-1499 grams: 2.82 billion 500-1499 grams: 2.60 billion 38 week survivor: 1.8 38 week survivor: 2,500 500-2499 grams: 3.50 billion 500-2499 grams: 3.23 billion 24 week survivor: 1.79 billion 24 week survivor: 1.62 billion 24 week survivor: 120 24 week N/A 25 week survivor: 1.28 billion 25 week survivor: 1.16 billion 25 week survivor: 86 survivor: 76 26 week survivor: 1.36 billion 26 week survivor: 1.23 billion 26 week survivor: 80 25 week survivor: 58 26 week survivor: 45 25-27 weeks: 5.25 billion 25-27 weeks: 4.55 billion 25-27 weeks: 71.2 N/A 25-27 weeks: 84,892 28-30weeks: 4.76 billion 28-30weeks: 4.12 billion 28-30weeks: 39.0 28-30weeks: 81,971 31-34 weeks: 4.35 billion 31-34 weeks: 3.77 billion 31-34 weeks: 11.8 31-34 weeks: 23,759 39-42 weeks: 8.7 billion 39-42 weeks: 7.54 billion 39-42 weeks: 3.1 39-42 weeks: 7,573 <37 weeks: $8.16 billion <37 weeks: 7.38 billion "premature survivor": 14.1 N/A N/A 3000-4500 grams: $5.85 billion3000-4500 grams: 5.29 billion 3000-4500 gram: 1.7 501-1500 grams: 3.93 billion 501-1500 grams: 3.56 billion 501-1500 grams: 49 N/A N/A 501-1000 grams: 2.89 billion 501-1000 grams: 2.61 billion 501-1000 grams: 75 24-26 weeks: 82 27-29 weeks: 58 30-32 weeks: 39 501-1500 grams: 3.69 billion 501-1500 grams: 3.55 billion 501-1500 grams: 47 N/A N/A 501-1000 grams: 2.72 billion 501-1000 grams: 2.62 billion 501-1000 grams: 73 24-26 weeks: 79 27-29 weeks: 55 30-32 weeks: 36 continued
From page 710...
... 710 PRETERM BIRTH TABLE D-3 Continued Per Per Patient Cost - Per Patient Cost Patient 2005 Dollars 2005 Dollars Study Cost Using Medical CPI Using Hospital PPI Schmitt (25) 500-999 grams: 205,218 500-999 grams: 221,450 500-999 grams: 222,104 500-1499 grams: 136,456 500-1499 grams: 147,249 500-1499 grams: 147,684 >2,500 grams: 1,647 >2,500 grams: 1,777 >2,500 grams: 1,783 St John (26)
From page 711...
... 711 APPENDIX D US Population US Population Cost Projection - Cost Projection - Per-Patient Per-Patient 2005 Dollars 2005 Dollars Per-Patient Ventilator Maternal Using Medical CPI Using Hospital PPI LOS Days Costs 500-999 grams: 7.70 billion 500-999 grams: 7.70 billion 500-999 grams: 64.4 N/A 500-999 grams: 11,609 500-1499 grams: 5.06 billion 501-1499 grams: 5.06 billion 500-1499 grams: 47.9 500-1499 grams: 12,183 >2,500 grams: 6.58 billion >2,500 grams: 6.58 billion >2,500 grams: 2.3 >2,500 grams: 3,378 < 37 weeks: 9.92 billion < 37 weeks: 8.59 billion N/A N/A N/A 30-34 weeks: 3.86 billion 30-34 weeks: 3.34 billion 37-42 weeks: 7.34 billion 37-42 weeks: 6.35 billion 500-999 grams: 2.41 billion 500-999 grams: 2.06 billion <1000 gram N/A N/A 37-41 weeks: 2.50 billion 37-41 weeks: 2.14 billion survivor: 106 Full term: N/A 500-999 grams: 1.55 billion 500-999 grams: 1.34 billion 500-999 grams: 500-999 grams: N/A 77 per live birth 23 per live birth Studies that reported both birth weight- and gestational age–specific costs show that these are consistent. Gilbert et al.
From page 712...
... 712 PRETERM BIRTH ies that used charges or failed to specify this were excluded, the range for the U.S. population was $1,545 to $1,900.
From page 713...
... TABLE D-4 Parental Out of Pocket Expenses and Lost Productivity During Initial Hospitalization Lost Productivity Paper Parental Wages of Child Child Care Other Travel Brazier (14) N/A N/A N/A N/A Per visit: 3-17 Per week: 27.98 Gennaro (30)
From page 714...
... 714 PRETERM BIRTH TABLE D-5 Direct Medical Expenses Following Discharge from the Initial Hospitalization Time Rehospitalization Outpatient MD, Paper Horizon (cost) Drug and Other (cost)
From page 715...
... 715 APPENDIX D Outpatient Post-Discharge Rehospitalization Rehospitalization Rehospitalization Visits (Clinic, Total (mean or median) (mean total days)
From page 716...
... 716 PRETERM BIRTH TABLE D-5 Continued Time Rehospitalization Outpatient MD, Paper Horizon (cost) Drug and Other (cost)
From page 717...
... 717 APPENDIX D Outpatient Postdischarge Rehospitalization Rehospitalization Rehospitalization Visits (Clinic, Total (mean or median) (mean total days)
From page 718...
... 718 PRETERM BIRTH TABLE D-6 Educational Expenditures Following Discharge from Initial Hospitalization Paper Pre-School Age School Age Chaikand (29) N/A <2500 Age 6-15: 1,240 (370.8 million total/yr)
From page 719...
... 719 APPENDIX D intervention services by gestational age. Infants born at less than 28 weeks of gestation had early intervention costs of $7,182 (in 2003 U.S.
From page 720...
... 720 TABLE D-7 Out-of-Pocket Expenses and Lost Productivity Following Discharge from Initial Hospitalization Lost Productivity Paper Parental Wages of Child Child Care Other Travel Tommiska (27) Year 1: N/A N/A "Home Aid" Year 1: <1,000: 5,990 Year 1: <1,000: 75 control: 880 <1,000: 0 control: 15 Year 2: control: 0 Year 2: <1,000: 8,175 Year 2: <1,000: 85 control: 595 <1,000: 255 control: 15 control: 85 McCormick (32)
From page 721...
... 721 APPENDIX D 5. Although the per-patient cost for moderately preterm infants is lower than that for extremely preterm infants, the larger numbers of these infants results in population costs of similar magnitudes in both groups.
From page 722...
... Costs of poor birth outcomes among privately insured. J Health Care Finance.
From page 723...
... 723 APPENDIX D 19. Kilpatrick SJ, Schlueter MA, Piecuch R, Leonard CH, Rogido M, Sola A
From page 724...
... Health care utilisation of prematurely born, preschool children related to hospitalisation for RSV infection. Arch Dis Child.


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